1164550265 NPI number — MRS. KIMBERLY MARIE SMITH MA CCCSLP TSHH

Table of content: MRS. KIMBERLY MARIE SMITH MA CCCSLP TSHH (NPI 1164550265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164550265 NPI number — MRS. KIMBERLY MARIE SMITH MA CCCSLP TSHH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
KIMBERLY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA CCCSLP TSHH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOBROWSKY
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA CCCSLP TSHH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164550265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 GRASSLANDS CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT SINAI
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-331-7632
Provider Business Mailing Address Fax Number:
631-331-7632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 GRASSLANDS CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT SINAI
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-375-3925
Provider Business Practice Location Address Fax Number:
631-267-2950
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  0120121 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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